Metatarsal fractures


Best answers
I'm new to this forum & posting stuff, so hopefully I get this right.

I work for a large podiatry group in Ohio. I have one somewhat major insurance company (only one, mind you) that insists that we put a toe modifier on a metatarsal fracture before they will process it for payment. They are doing this on bunionectomies as well. As everyone knows, there are no modifiers in existence for metatarsals....and bunionectomies pretty much speak for themselves - they can only inflict the 1st MPJ or 5th MPJ, if a Tailors' bunionectomy. We have talked with several other podiatrists, and they think it is OK to place a toe modifier on these codes just so they can get payment. I have stood my ground on this issue, & I refuse to put that modifier on there. It doesn't belong! So, I send the notes in for review. Now, what I've discovered is that the ins. co. actually put the toe modifier on that fracture code themselves & put the claim through for processing. Are they allowed to do that?? I understood that a superbill is a legal document, & no changes are to be made unless confirmed by the doctor. Does this ins. co. actually have any legal right to make changes like this to our claims? What blows my mind is that Medicare does not require toe modifiers for these codes, so why should anyone else? Most ins. co. kind of look to Medicare as the "mother ship". I'm appalled at the actions of this ins. co., & I was curious if anyone has any expertise as to the legalities of what an ins. co. can & cannot do with our claims once received in their system.